Premature birth impacts bolus size and shape through nursing in infant pigs
BACKGROUND: The formation of a bolus of food is critical for proper feeding function, and there is substantial variation in the size and shape of a bolus prior to a swallow. Preterm infants exhibit decreased abilities to acquire and process food, but how that relates to their bolus size and shape is unknown. Here, we test two hypotheses: (1) that bolus size and shape will differ between term and preterm infants, and (2) bolus size and shape will change longitudinally through development in both term and preterm infants. METHODS: To test these hypotheses, we measured bolus size and shape in preterm and term infant pigs longitudinally through nursing using high-speed videofluoroscopy. RESULTS: Preterm infant pigs swallowed smaller volumes of milk. Although term infants increased the amount of milk per swallow as they aged, preterm infants did not. These changes in bolus volume were also correlated with changes in bolus shape; larger boluses became more elongate as they better filled the available anatomical space of the valleculae. CONCLUSIONS: These results suggest that preterm birth reduces the ability of preterm pigs to increase bolus size as they grow, affecting development in this fragile population. These results highlight that studies on term infant feeding may not translate to preterm infants.
Mayerl Christopher J; Myrla Alexis M; Bond Laura E; Stricklen Bethany M; German Rebecca Z; Gould Francois D H
Pediatric Research
2019
2019-10-23
Journal Article
<a href="http://doi.org/10.1038/s41390-019-0624-0" target="_blank" rel="noreferrer noopener">10.1038/s41390-019-0624-0</a>
PMID: 31645052
Swallow Safety is Determined by Bolus Volume During Infant Feeding in an Animal Model.
Animal model; aspiration; children born; coordination; dysphagia; dysphagia; Feeding; laryngeal nerve lesion; low-birth-weight; Neonate; patent ductus-arteriosus; Performance; pharyngeal swallow; preterm; respiration
Feeding difficulties are especially prevalent in preterm infants, although the mechanisms driving these difficulties are poorly understood due to a lack of data on healthy infants. One potential mechanism of dysphagia in adults is correlated with bolus volume. Yet, whether and how bolus volume impacts swallow safety in infant feeding is unknown. A further complication for safe infant swallowing is recurrent laryngeal nerve (RLN) injury due to patent ductus arteriosus surgery, which exacerbates the issues that preterm infants face and can increase the risk of dysphagia. Here, we used a validated animal model feeding freely to test the effect of preterm birth, postnatal maturation and RLN lesion and their interactions on swallow safety. We also tested whether bolus size differed with lesion or birth status, and the relationship between bolus size and swallow safety. We found very little effect of lesion on swallow safety, and preterm infants did not experience more penetration or aspiration than term infants. However, term infants swallowed larger boluses than preterm infants, even after correcting for body size. Bolus size was the primary predictor of penetration or aspiration, with larger boluses being more likely to result in greater degrees of dysphagia irrespective of age or lesion status. These results highlight that penetration and aspiration are likely normal occurrences in infant feeding. Further, when comorbidities, such as RLN lesion or preterm birth are present, limiting bolus size may be an effective means to reduce incidences of penetration and aspiration.
Mayerl Christopher J; Myrla Alexis M; Gould Francois D H; Bond Laura E; Stricklen Bethany M; German Rebecca Z
Dysphagia
2020
2020-04-24
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1007/s00455-020-10118-x" target="_blank" rel="noreferrer noopener">10.1007/s00455-020-10118-x</a>